Kristine J. Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005593A Issued in IN

Practice address

3105 S Sare Rd Apt 300
Bloomington, IN 47401-4378

Phone

(812) 333-3939

Fax

(812) 585-3802

NPI assigned

Oct 7, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kris Sullivan LCSW

  • Social Worker
  • Bloomington, IN
  • NPI 1487366027
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1851542096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 S SARE RD APT 300",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014378",
            "telephone_number": "812-333-3939",
            "fax_number": "812-585-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 S SARE RD APT 300",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014378",
            "telephone_number": "812-333-3939",
            "fax_number": "812-585-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KRISTINE",
        "middle_name": "J.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005593A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Sudrovech, LCSW
• Sue'S Center Inc
• Sue'S Center LLC
• Cynyrlynne Lola Suganob, PT, DPT
• James M Sullivan, M.D.
• Thomas Mann Sullivan, LCSW LMFT
• Mohamed Owais Sultan
• Maria Summers, DDS
• Alexandra Sumpter, RBT
• Kevin F Sumption, MD

• Clinical Social Worker in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.